Bond Dale S, Thomas J Graham, Lipton Richard B, Roth Julie, Pavlovic Jelena M, Rathier Lucille, O'Leary Kevin C, Evans E Whitney, Wing Rena R
Weight Control and Diabetes Research Center, The Miriam Hospital/Brown Alpert Medical School, Providence, Rhode Island, USA.
Montefiore Headache Center, Albert Einstein College of Medicine, Bronx, New York, New York, USA.
Obesity (Silver Spring). 2018 Jan;26(1):81-87. doi: 10.1002/oby.22069. Epub 2017 Nov 27.
The objective of this study was to test whether behavioral weight loss (BWL) intervention decreases headaches in women with comorbid migraine and overweight or obesity.
This randomized, single-blind trial allocated women 18 to 50 years old with 4 to 20 migraine days per month and a BMI = 25.0-49.9 kg/m to 16 weeks of BWL (n = 54), which targeted exercise and eating behaviors for weight loss, or to migraine education control (ME, n = 56), which delivered didactic instruction on migraine and treatments. Participants completed a 4-week smartphone headache diary at baseline, posttreatment (16-20 wk), and follow-up (32-36 wk). The primary outcome was posttreatment change in migraine days per month, analyzed via linear mixed effects models.
Of 110 participants randomly assigned, 85 (78%) and 80 (73%) completed posttreatment and follow-up. Although the BWL group achieved greater weight loss (mean [95% CI] in kilograms) than the ME group at posttreatment (-3.8 [-2.5 to -5.0] vs. + 0.9 [-0.4 to 2.2], P < 0.001) and follow-up (-3.2 [-2.0 to -4.5] vs. + 1.1 [-0.2 to 2.4], P < 0.001), there were no significant group (BWL vs. ME) differences (mean [95% CI]) in migraine days per month at posttreatment (-3.0 [-2.0 to -4.0] vs. -4.0 [-2.9 to -5.0], P = 0.185) or follow-up (-3.8 [-2.7 to -4.8] vs. -4.4 [-3.4 to -5.5], P = 0.378).
Contrary to hypotheses, BWL and ME yielded similar, sustained reductions in migraine headaches. Future research should evaluate whether adding BWL to standard pharmacological and/or nonpharmacological migraine treatment approaches yields greater benefits.
本研究旨在测试行为减肥（BWL）干预是否能减少合并偏头痛及超重或肥胖的女性的头痛发作。
这项随机、单盲试验将年龄在18至50岁、每月有4至20个偏头痛日且BMI为25.0 - 49.9kg/m²的女性分为两组，一组接受为期16周的BWL干预（n = 54），该干预以运动和饮食行为为目标来实现减肥；另一组接受偏头痛教育对照（ME，n = 56），即提供有关偏头痛及治疗的教学指导。参与者在基线、治疗后（16 - 20周）和随访（32 - 36周）时完成一份为期4周的智能手机头痛日记。主要结局是每月偏头痛天数的治疗后变化，通过线性混合效应模型进行分析。
在随机分配的110名参与者中，85名（78%）和80名（73%）完成了治疗后及随访。尽管BWL组在治疗后（-3.8[-2.5至-5.0] vs. +0.9[-0.4至2.2]，P < 0.001）和随访时（-3.2[-2.0至-4.5] vs. +1.1[-0.2至2.4]，P < 0.001）比ME组实现了更大程度的体重减轻（以千克计的均值[95%CI]），但在治疗后（-3.0[-2.0至-4.0] vs. -4.0[-2.9至-5.0]，P = 0.185）和随访时（-3.8[-2.7至-4.8] vs. -4.4[-3.4至-5.5]，P = 0.378），两组在每月偏头痛天数方面没有显著差异（均值[95%CI]）。
与假设相反，BWL和ME在偏头痛头痛方面产生了相似的、持续的减少。未来的研究应评估在标准的药物和/或非药物偏头痛治疗方法中加入BWL是否会带来更大益处。
